| NPI | 1538367149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARREN S THEIS Owner 912-285-8822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 055345) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: GA 055345) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2024-07-01 |